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Izzat N, Abu-Farha R, Harahsheh MM, Thiab S. A qualitative assessment of anabolic-androgenic steroid use among gym users in Jordan: motives, perception, and safety. Int J Legal Med 2023; 137:1421-1430. [PMID: 37355480 DOI: 10.1007/s00414-023-03046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Over the years, the use of anabolic-androgenic steroids (AAS) has become widespread among athletes and bodybuilders. The prevalence of their use has been estimated at around 20 to 50% globally. Unfortunately, many athletes do not have the proper knowledge about the effects of these banned substances Thus, this study aims to qualitatively assess Jordanian gym users' AAS intentions, perceptions, and safety. METHODS Twenty male Jordanian anabolic steroid users were interviewed using in-depth interviews as part of a qualitative study evaluating the motivations, perceptions, and safety of AAS among gym users. RESULTS The findings of this study indicate that the desire to compete in bodybuilding contests was the primary motivation for participants to use AAS. The study participants mentioned using a combination of oral and injectable medications. Gym coaches and trainers were also identified as an essential source of information for AAS use. A very limited number of AAS users were getting their information from healthcare providers, and most of them have experienced some of these medications side effects but are still willing to continue the use of AAS to get what they need in terms of their physical appearance or for winning competitions. CONCLUSION There is an urgent need for structured awareness campaigns targeting gyms and fitness clubs' members to increase their knowledge about the side effects and health risks associated with the use of AAS. In addition, sports governing bodies should have stricter measures to tackle this problem and discourage athletes from using such products.
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Affiliation(s)
- Nawal Izzat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, P.O. Box 11937, Amman, Jordan
| | - Rana Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, P.O. Box 11937, Amman, Jordan.
| | - Mea'ad M Harahsheh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Samar Thiab
- Department of Pharmaceutical Chemistry and Pharmacognosy, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
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Hoff D. Positiva upplevelser av dopning: En kvalitativ studie av AAS-bruk och reflexiva kroppar [Positive experiences of doping: A qualitative study of AAS-use and reflexive bodies]. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:146-162. [PMID: 35757092 PMCID: PMC9189561 DOI: 10.1177/14550725211053130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/05/2021] [Accepted: 09/28/2021] [Indexed: 12/05/2022] Open
Abstract
Research on doping usually has focused on social and individual problems, such as AAS-use in relations to substance abuse, criminality and health issues. The purpose of this study was to analyze the meaning of positive experiences of doping with Anabolic Androgenic Steroids (AAS), outside the traditional sports competition context. Eight respondents with own AAS-experiences were interviewed. The theoretical framework was elaborated from Giddens’ discussion on individuals’ self-reflexivity and the construction of the self-identity in the late modern age. The respondents’ narratives were analyzed in four themes: (1) To be big and strong – masculine self-identity; (2) Revenge and to become a part of a community; (3) AAS and training as an “exit” from risk behavior and substance use; (4) Euphoria generator and anxiety reducer. The themes were analyzed as different processes of the respondents’ constructions of new self-identities and lifestyles using their reflexive bodies in body regimes where weight training and use of AAS were crucial.
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Affiliation(s)
- David Hoff
- School of Social Work, Lund University, Lund, Sweden
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Börjesson A, Ekebergh M, Dahl ML, Ekström L, Lehtihet M, Vicente V. Women's Experiences of Using Anabolic Androgenic Steroids. Front Sports Act Living 2021; 3:656413. [PMID: 34859201 PMCID: PMC8632252 DOI: 10.3389/fspor.2021.656413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Anabolic androgenic steroids are used by women to increase their muscle mass and because of their performance-enhancing effects. Despite permanent/high risk of side effects, knowledge is inadequate. Our aim has been to deepen understanding about women's use of anabolic androgenic steroids. This phenomenological study is based on the reflective lifeworld research (RLR) approach. Lifeworld interviews were conducted with 12 women, aged 21-56 years, about their experiences of using anabolic steroids. The results show that women experience a sense of pride when they successfully achieve their goals. This is the driving force, triggering tension between suffering and success. Our research adds important knowledge from a reflective lifeworld perspective and shows that women's use of anabolic androgenic steroids is a complex phenomenon. Understanding and knowledge are important in order to be able to meet and support women in their fears and difficulties.
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Affiliation(s)
- Annica Börjesson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Margaretha Ekebergh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Marja-Liisa Dahl
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Lehtihet
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Vicente
- Department of Clinical Science and Education, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
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Abstract
PURPOSE OF REVIEW To summarize the most recent evidence regarding nonprescribed androgen use among women and trans men. RECENT FINDINGS Fourteen heterogeneous studies met inclusion criteria. Three provided lifetime prevalence estimates among particular subgroups (from 0.5 to 8%), whereas one longitudinal study found adverse childhood experiences predicted later nonprescribed androgen use. Mental health and substance problems appear to correlate with severity of use, but evidence is mixed as to whether female users had lower or equal mental health burdens compared to male users. Studies that discuss motivation highlighted the dynamic risk management that underlies decisions to continue use; benefits have to outweigh undesired effects, whereas some sexual side effects are re-framed to be positive. Finally, a theme among qualitative studies is the gendered experiences of nonprescribed androgen use, and the search for knowledge and communities created by women. SUMMARY Prevalence, side effects, and trajectories of use appear to be different for women than men. Women users need gender-specific information, although some are able to navigate male-dominated knowledge sources and are creating a female ethnopharmacology that privileges women's experiences. Health research, including epidemiology, gravely needs a gender perspective when examining nonprescribed androgen use, and one that is inclusive of transgender people.
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Aziz SA. Attitude and health issue awareness of anabolic androgenic steroids use among male gym users in some gym centers in Sulaymaniyah city, Iraq. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1879294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sadat Abdulla Aziz
- Department of Basic Sciences, College of Veterinary Medicine, University of Sulaimani, Sulaymaniyah, Iraq
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Anabolic-androgenic steroid use among women - A qualitative study on experiences of masculinizing, gonadal and sexual effects. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 95:102876. [PMID: 32736958 DOI: 10.1016/j.drugpo.2020.102876] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/24/2020] [Accepted: 07/20/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Female users of anabolic-androgenic steroids (AAS) are at risk of developing masculinizing side effects. This study explores how the development of masculinizing effects has been experienced and processed by women with current or previous AAS use. METHODS Individual, semi-structured interviews were undertaken among 16 current or previous AAS-using women. The interviews were recorded, transcribed verbatim and thematically analyzed. RESULTS Almost all of the women were introduced to AAS and advised about what substance(s) to use, how much to use and how to use it by a trusted male partner, friend or coach. For some, AAS initiation was an impulsive choice, while others wanted to overcome stagnation and/or prepare for fitness competitions. Many were unprepared for the unwanted masculinizing effects, but some experienced these to be outweighed by the desired effects. Masculinizing effects that could be mediated by hair removal or breast implants were easier to process than a deepened voice. As very few women were open with others about their AAS use, the voice change could disclose use and was often accompanied by feelings of shame and regret. Absence of menstruation and its return following cessation were used to monitor effect, normal function and safety when deciding when to start a new cycle. Clitoral enlargement gave rise to shame and reduced self-esteem, but negative emotions could be reduced by a positive partner response. Increased libido was common and gave rise to positive and negative experiences, depending on life situation, partner status, whether the partner used AAS simultaneously and whether genital changes had also been experienced. CONCLUSION Women who use AAS are at risk of developing irreversible masculinizing effects that are difficult to process and that may negatively influence self-esteem, social life and sexual function, both during and after use. More gender-specific information about women and AAS use is needed.
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Börjesson A, Möller C, Hagelin A, Vicente V, Rane A, Lehtihet M, Dahl ML, Gårevik N, Ekström L. Male Anabolic Androgenic Steroid Users with Personality Disorders Report More Aggressive Feelings, Suicidal Thoughts, and Criminality. ACTA ACUST UNITED AC 2020; 56:medicina56060265. [PMID: 32481676 PMCID: PMC7353874 DOI: 10.3390/medicina56060265] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: Anabolic androgenic steroids (AAS) are mainly used for aesthetic and performance-enhancing reasons. Their use is a growing public health problem and concern for society because of their adverse effects. The primary aim of this study was to identify psychiatric and personality disorders and to measure anxiety and depression in AAS users. Materials and Methods: Fifty-six males who actively contacted the Anti-Doping Hot-Line and wished to stop using AAS were included. Structured Clinical Interviews Diagnosis-I and -II were used to diagnose psychiatric and personality disorders. The Brief Scale for Anxiety and Montgomery Asberg Depression Rating Scale (subscales from the Comprehensive Psychopathological Rating Scale) were used to measure changes in anxiety and depression. Structured Clinical Interviews Diagnosis-I and -II were performed at one time point. Anxiety and depression were measured at inclusion and after six months. Urine samples were collected for an analysis of AAS and drugs of abuse. Results: All participants reported some adverse effects that they associated with AAS use. In total, 56% and 52% of the cohort fulfilled the criteria for Structured Clinical Interviews Diagnosis-I and -II diagnoses, respectively. A significantly increased risk of reporting aggressive feelings/behaviors (Odds Ratio (OR) = 4.9; Confidence Interval (CI) 0.99-25, p = 0.04), suicidal thoughts/attempts (OR = 4.6, CI 95; 0.99-21, p = 0.04) and criminality (OR = 6.5, CI 1-39, p = 0.03) was found among individuals with AAS use fulfilling the criteria for personality disorders compared with those without such AAS use. The Brief Scale for Anxiety score decreased from the median of 15 at inclusion to 10 at the follow-up visit six months later (p = 0.01, n = 19). Conclusions: Our findings indicate that among individuals with AAS use, those with a personality disorder report more aggressive behaviors, suicidal thoughts/suicidal attempts, and criminality than those without a personality disorder.
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Affiliation(s)
- Annica Börjesson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
- Correspondence: ; Tel.: +46-8-585-811-92
| | - Christian Möller
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Psychiatric Clinic, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, 422 49 Gothenburg, Sweden
| | - Anders Hagelin
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
| | - Veronica Vicente
- The Ambulance Medical Service in Stockholm (AISAB), Academic EMS, 121 63 Stockholm, Sweden;
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anders Rane
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
| | - Mikael Lehtihet
- Department of Medicine, Karolinska Institutet, S:t Görans Hospital, 122 19 Stockholm, Sweden;
| | - Marja-Liisa Dahl
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
| | - Nina Gårevik
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
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Abstract
OBJECTIVE Anabolic-androgenic steroids (AAS) represents a group of synthetic testosterone derivatives that play an important role in clinical treatment. These drugs are widely abused among the general public to increase lean weight and improve athletic performance. It has been reported that AAS use can produce many adverse effects, especially the occurrence of cardiovascular risk. Although there are many related studies, there has been no consensus on AAS use and cardiovascular risk. The present study was to review the effect of AAS on the cardiovascular system. DATA SOURCES The data in this review were obtained from articles included in PubMed and the National Center for Biotechnology Information database. STUDY SELECTION Original articles, case reports, and systematic reviews about AAS were selected for the article. RESULTS The use/abuse of AAS is correlated with higher cardiovascular risks, and many AAS users/abusers had cardiovascular diseases. However, there are many confounding factors in the studies that explored the causality between AAS intake and disease development, and additional studies are required to determine AAS toxicity. CONCLUSION AAS produces toxic effects on the cardiovascular system, and it is necessary to ensure that more people know this about AAS, including medical personnel.
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Affiliation(s)
- Jian-Di Liu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
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Harvey O, Keen S, Parrish M, van Teijlingen E. Support for people who use Anabolic Androgenic Steroids: A Systematic Scoping Review into what they want and what they access. BMC Public Health 2019; 19:1024. [PMID: 31366349 PMCID: PMC6670144 DOI: 10.1186/s12889-019-7288-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/09/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Since there is a paucity of research on support for people using Anabolic Androgenic Steroids (AAS), we aimed to identify and synthesise the available evidence in this field. Gaining an understanding of the support both accessed and wanted by recreational AAS users will be of use to professionals who provide services to intravenous substance users and also to those working in the fields of public health and social care, with the aim to increase engagement of those using AAS. METHODS A systematic scoping review of the literature to explore and identify the nature and scope of information and support both accessed and wanted by non-prescribed AAS users. Any support services or information designed to help people who use AAS were considered. RESULTS We identified 23 papers and one report for review, which indicated that AAS users access a range of sources of information on: how to inject, substance effectiveness, dosages and side effects, suggesting this is the type of information users want. AAS users sought support from a range of sources including medical professionals, needle and syringe programmes, friends, dealers, and via the internet, suggesting that, different sources were used dependent on the information or support sought. DISCUSSION AAS users tended to prefer peer advice and support over that of professionals, and access information online via specialist forums, reflecting the stigma that is experienced by AAS users. These tendencies can act as barriers to accessing services provided by professionals. CONCLUSIONS Support needs to be specific and targeted towards AAS users. Sensitivity to their perceptions of their drug-use and the associated stigma of being classified in the same sub-set as other illicit drug users is relevant to facilitating successful engagement.
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Affiliation(s)
- Orlanda Harvey
- Bournemouth University, Lansdowne Campus, Royal London House, 109 Christchurch Road, Bournemouth, BH1 3LT UK
| | - Steve Keen
- Bournemouth University, Lansdowne Campus, Royal London House, 109 Christchurch Road, Bournemouth, BH1 3LT UK
| | - Margarete Parrish
- Bournemouth University, Lansdowne Campus, Royal London House, 109 Christchurch Road, Bournemouth, BH1 3LT UK
| | - Edwin van Teijlingen
- Bournemouth University, CMMPH, Bournemouth House, 19 Christchurch Road, Bournemouth, BH1 3LH UK
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Havnes IA, Jørstad ML, Wisløff C. Anabolic-androgenic steroid users receiving health-related information; health problems, motivations to quit and treatment desires. Subst Abuse Treat Prev Policy 2019; 14:20. [PMID: 31096999 PMCID: PMC6524231 DOI: 10.1186/s13011-019-0206-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/15/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anabolic-androgenic steroids (AAS) are used to increase muscle strength and improve appearance, but users also carry the risk of developing physical and mental health problems. In Norway, the substance use disorder treatment system provides health care to this patient group, but few AAS users have sought such treatment. Therefore, a service was created to inform AAS users and next of kin of potential negative consequences and their treatment options. This study describes health problems, motivations for AAS cessation, and treatment desires among AAS users. METHODS Over four years, 232 AAS users and 60 next of kin contacted the information service and received an hour-long information session with healthcare personnel. Information about AAS use, physical and mental health problems, substance use, motivation for cessation, and whether the information seeker desired treatment were registered. Qualitative interviews were conducted among seven individuals and analyzed thematically to explore information service experiences. RESULTS Of the 232 AAS users, 179 (77.2%) desired treatment after completing the information session and 53 (22.9%) were unsure or did not want treatment. Those who desired treatment were significantly older, had used AAS longer, reported more physical and mental health side effects, and a higher proportion reported having children than those who did not desire treatment. Although 181 (78.0%) reported co-occuring physical and mental health problems, mental health problems were the most common motivation for AAS cessation (n = 108, 47.8%), followed by a combination of mental and physical health problems (52, 23.0%). Findings from qualitative interviews suggest that barriers to treatment may be overcome with an easily accessible service that informs about addiction treatment and facilitates the treatment entry process. CONCLUSIONS Healthcare professionals who encounter users of AAS should have knowledge about AAS use and adverse effects. The desire for health care reveals extensive health problems and the user group is so non-homogeneous that examination and treatment must be adapted individually with focus on physical, mental and social factors as well as possible dependence of AAS and/or psychoactive substances.
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Affiliation(s)
- Ingrid Amalia Havnes
- National Advisory Unit on Substance Use Disorder Treatment, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen, 0424 Oslo, Norway
| | - Marie Lindvik Jørstad
- National Advisory Unit on Substance Use Disorder Treatment, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen, 0424 Oslo, Norway
| | - Christine Wisløff
- National Advisory Unit on Substance Use Disorder Treatment, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen, 0424 Oslo, Norway
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Greenway CW, Price C. A qualitative study of the motivations for anabolic-androgenic steroid use: The role of muscle dysmorphia and self-esteem in long-term users. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.peh.2018.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Börjesson A, Gårevik N, Dahl ML, Rane A, Ekström L. Recruitment to doping and help-seeking behavior of eight female AAS users. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:11. [PMID: 26945991 PMCID: PMC4779574 DOI: 10.1186/s13011-016-0056-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/02/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Doping with anabolic androgenic steroids in sports has now developed to a widespread use of these agents among young people outside the sport. This is of major concern to the society. The purpose of the use is mainly for aesthetic reasons and is seen as a male phenomenon. But use also occurs in women where the knowledge is scarce. Our aim was to identify the pattern of doping agents in eight female cases and compare them with similar data from men. METHODS Eight female users were recruited through Anti-Doping Hot-Line, a national telephone counseling service on doping issues during the years 1998-2004. The use was confirmed with urine doping analysis at the Doping Laboratory. The characteristic of use, co-use of narcotics/other doping agents, exercise pattern, adverse-side effects, family history and reason to begin was evaluated. RESULTS The women used on average 1.9 different anabolic androgenic steroids and clenbuterol preparations. Ephedrine and growth hormone were co-used in five and one of the women, respectively. Three women reported co-use of narcotics (cannabis and cocaine). The average duration of anabolic agent use before contacting health care was 58 weeks (range 7-104). Side effects for anabolic androgenic steroids (n = 5) included voice changes, clitoral enlargement, body hair growth, whereas women using clenbuterol (n = 2) reported tachycardia and depression. All women except one had a man in close relationship encouraging them to begin with the doping agents. CONCLUSIONS The use of doping agents in our eight women was different from that in male users. The women used less doping agents and were more prone to contact the health care, at an earlier stage, probably due to the adverse effects. The co-use with ephedrine, growth hormone and cannabis appeared to be in the same range as in men. This is the first study showing that a man in close relationship may motivate a woman to use anabolic agents.
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Affiliation(s)
- Annica Börjesson
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Nina Gårevik
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Marja-Liisa Dahl
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Anders Rane
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Lena Ekström
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
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ANGOORANI H, HALABCHI F. The Misuse of Anabolic-Androgenic Steroids among Iranian Recreational Male Body-Builders and Their Related Psycho-Socio-Demographic factors. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:1662-9. [PMID: 26811817 PMCID: PMC4724739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The high prevalence and potential side effects of anabolic-androgenic steroids (AAS) misuse by athletes has made it a major public health concern. Epidemiological studies on the abuse of such drugs are mandatory for developing effective preventive drug control programs in sports community. This study aimed to investigate the prevalence of AAS abuse and their association with some psycho-socio-demographic factors in Iranian male recreational body-builders. METHODS Between March and October 2011; 906 recreational male body-builders from 103 randomly selected bodybuilding clubs in Tehran, Iran were participated in this study. Some psycho-socio- demographic factors including age, job, average family income, family size, sport experience (months), weekly duration of the sporting activity (h), purpose of participation in sporting activity, mental health as well as body image (via General Health Questionnaire and Multidimensional Body-Self Relations Questionnaire, respectively), and history of AAS use were obtained by interviews using questionnaires. RESULTS Participants were all recreational male body-builders [mean age (SD): 25.7 (7.1), ranging 14-56 yr]. Self-report of AAS abuse was registered in 150 body-builders (16.6%). Among different psycho-socio-demographic factors, only family income and sport experience were inversely associated with AAS abuse. CONCLUSION Lifetime prevalence of AAS abuse is relatively high among recreational body-builders based on their self-report. Some psycho-socio-demographic factors including family income and sport experience may influence the prevalence of AAS abuse.
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Affiliation(s)
- Hooman ANGOORANI
- Dept. of Sports and Exercise Medicine, Hazrat Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farzin HALABCHI
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran,Dept. of Sports and Exercise Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
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Seear K, Fraser S, Moore D, Murphy D. Understanding and responding to anabolic steroid injecting and hepatitis C risk in Australia: A research agenda. DRUGS-EDUCATION PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1061975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sagoe D, McVeigh J, Bjørnebekk A, Essilfie MS, Andreassen CS, Pallesen S. Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:12. [PMID: 25888931 PMCID: PMC4377045 DOI: 10.1186/s13011-015-0006-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/24/2015] [Indexed: 02/07/2023]
Abstract
Background As far as we are aware, no previous systematic review and synthesis of the qualitative/descriptive literature on polypharmacy in anabolic-androgenic steroid(s) (AAS) users has been published. Method We systematically reviewed and synthesized qualitative/descriptive literature gathered from searches in electronic databases and by inspecting reference lists of relevant literature to investigate AAS users’ polypharmacy. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines. Results A total of 50 studies published between 1985 and 2014 were included in the analysis. Studies originated from 10 countries although most originated from United States (n = 22), followed by Sweden (n = 7), England only (n = 5), and the United Kingdom (n = 4). It was evident that prior to their debut, AAS users often used other licit and illicit substances. The main ancillary/supplementary substances used were alcohol, and cannabis/cannabinoids followed by cocaine, growth hormone, and human chorionic gonadotropin (hCG), amphetamine/meth, clenbuterol, ephedra/ephedrine, insulin, and thyroxine. Other popular substance classes were analgesics/opioids, dietary/nutritional supplements, and diuretics. Our classification of the various substances used by AAS users resulted in 13 main groups. These non-AAS substances were used mainly to enhance the effects of AAS, combat the side effects of AAS, and for recreational or relaxation purposes, as well as sexual enhancement. Conclusions Our findings corroborate previous suggestions of associations between AAS use and the use of other licit and illicit substances. Efforts must be intensified to combat the debilitating effects of AAS-associated polypharmacy.
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Affiliation(s)
- Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015, Bergen, Norway.
| | - Jim McVeigh
- Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, Liverpool, L3 2ET, UK.
| | - Astrid Bjørnebekk
- Department of Physical Medicine and Rehabilitation, Unit of Neuropsychology, Oslo University Hospital, Kirkeveien 166, Ullevål, Norway.
| | | | - Cecilie Schou Andreassen
- Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015, Bergen, Norway. .,The Competence Centre, Bergen Clinics Foundation, Vestre Torggate 11, 5015, Bergen, Norway.
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015, Bergen, Norway.
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Sagoe D, Andreassen CS, Pallesen S. The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:27. [PMID: 24984881 PMCID: PMC4091955 DOI: 10.1186/1747-597x-9-27] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/26/2014] [Indexed: 12/31/2022]
Abstract
Background To our knowledge, there has never been a systematic review and synthesis of the qualitative literature on the trajectory and aetiology of nonmedical anabolic-androgenic steroid (AAS) use. Methods We systematically reviewed and synthesized qualitative literature gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference lists of relevant literature to investigate AAS users’ ages of first use and source(s), history prior to use, and motives/drives for initiating use. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines. Results A total of 44 studies published between 1980 and 2014 were included in the synthesis. Studies originated from 11 countries: the United States (n = 18), England (n = 8), Australia (n = 4), Sweden (n = 4), both England and Wales (n = 2), and Scotland (n = 2). One study each originated from Brazil, Bulgaria, Canada, France, Great Britain, and Norway. The majority of AAS users initiated use before age 30. Sports participation (particularly power sports), negative body image, and psychological disorders such as depression preceded initiation of AAS use for most users. Sources of first AAS were mainly users’ immediate social networks and the illicit market. Enhanced sports performance, appearance, and muscle/strength were the paramount motives for AAS use initiation. Conclusions Our findings elucidate the significance of psychosocial factors in AAS use initiation. The proliferation of AAS on the illicit market and social networks demands better ways of dealing with the global public health problem of AAS use.
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Affiliation(s)
- Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015 Bergen, Norway.
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Kimergård A, McVeigh J. Environments, risk and health harms: a qualitative investigation into the illicit use of anabolic steroids among people using harm reduction services in the UK. BMJ Open 2014; 4:e005275. [PMID: 24898090 PMCID: PMC4054627 DOI: 10.1136/bmjopen-2014-005275] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The illicit use of anabolic steroids among the gym population continues to rise, along with the number of steroid using clients attending harm reduction services in the UK. This presents serious challenges to public health. Study objectives were to account for the experiences of anabolic steroid users and investigate how 'risk environments' produce harm. METHODS Qualitative face-to-face interviews with 24 users of anabolic steroids engaged with harm reduction services in the UK. RESULTS Body satisfaction was an important factor when deciding to start the use of anabolic steroids. Many users were unaware of the potential dangers of using drugs from the illicit market, whereas some had adopted a range of strategies to negotiate the hazards relating to the use of adulterated products, including self-experimentation to gauge the perceived efficacy and unwanted effects of these drugs. Viewpoints, first-hand anecdotes, norms and practices among groups of steroid users created boundaries of 'sensible' drug use, but also promoted practices that may increase the chance of harms occurring. Established users encouraged young users to go to harm reduction services but, at the same time, promoted risky injecting practices in the belief that this would enhance the efficacy of anabolic steroids. CONCLUSIONS Current steroid-related viewpoints and practices contribute to the risk environment surrounding the use of these drugs and may undermine the goal of current public health strategies including harm reduction interventions. The level of harms among anabolic steroid users are determined by multiple and intertwining factors, in addition to the harms caused by the pharmacological action or injury and illness associated with incorrect injecting techniques.
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Affiliation(s)
- Andreas Kimergård
- Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
- Centre for Public Health, Liverpool John Moores University, Liverpool, UK
| | - Jim McVeigh
- Centre for Public Health, Liverpool John Moores University, Liverpool, UK
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Björk T, Skårberg K, Engström I. Eating disorders and anabolic androgenic steroids in males--similarities and differences in self-image and psychiatric symptoms. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:30. [PMID: 23958408 PMCID: PMC3751698 DOI: 10.1186/1747-597x-8-30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 08/07/2013] [Indexed: 11/12/2022]
Abstract
Background Body dissatisfaction is common among both females and males. Dissatisfaction with the body is a risk factor both for onset of eating disorders and for abuse of anabolic androgenic steroids (AAS). Few studies have however investigated if there are other similarities in respect to self-image or psychiatric symptoms between clinical samples of eating disordered males and males in treatment for negative effects of AAS use. Aim The aim of this study was to compare two clinical samples, one of males with ED and one of males who used AAS, regarding self-image and psychiatric symptoms. Methods This study compared males with eating disorders (n = 13) and males who recently stopped AAS use (n = 29) on self-image and psychiatric symptoms, using The Structural Analysis of Social Behavior self-questionnaire and a shortened version of The Symptom Check List. Results The eating disorder group reported significantly lower scores for Self-emancipation and Active self-love and higher scores for Self-blame and Self-hate. Both groups reported serious psychiatric symptoms. The common denominator between groups was serious psychiatric symptomatology rather than negative self-image. Conclusions The negative self-image profile, especially self-hate, found among males with Eating Disorders may indicate that the studied groups differ in aetiology of the underlying problems. The serious psychiatric symptoms in both groups call staff to pay attention to any thoughts of suicide due to severe depressive symptoms where by specialized psychiatric treatment may be needed.
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Affiliation(s)
- Tabita Björk
- Department of Clinical Neuroscience, Psychiatry, Karolinska Institute, Stockholm, Sweden.
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Christiansen AV, Bojsen-Møller J. “Will steroids kill me if I use them once?” A qualitative analysis of inquiries submitted to the Danish anti-doping authorities. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.peh.2012.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Santos AM, da Rocha MSP, da Silva MF. Illicit use and abuse of anabolic-androgenic steroids among Brazilian bodybuilders. Subst Use Misuse 2011; 46:742-8. [PMID: 21114402 DOI: 10.3109/10826084.2010.534123] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Anabolic-androgenic steroids (AAS) are used to enhance performance and appearance. The aim of this research was to assess the knowledge of AAS among Brazilian bodybuilders. The sample was comprised of 123 male participants between the ages of 18 and 50 years. Questionnaires were administered to bodybuilders from gyms in the district capital and in the rural area of Pernambuco, state of northeast of Brazil, in 2008. We analyzed the use and abuse of AAS from several different perspectives among the bodybuilders. For the participants in our study, enhanced appearance justifies the misuse of AAS. The study's limitations are noted.
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Affiliation(s)
- Azenildo Moura Santos
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Alameda Benevento, Salvador, Brazil.
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Thorlindsson T, Halldorsson V. Sport, and use of anabolic androgenic steroids among Icelandic high school students: a critical test of three perspectives. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2010; 5:32. [PMID: 21172024 PMCID: PMC3022538 DOI: 10.1186/1747-597x-5-32] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 12/20/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study investigates the use of anabolic androgenic steroids (AAS) among a national representative sample of high school students in Iceland. We test several hypotheses drawn from three perspectives. The first perspective focuses on the use of AAS as an individual phenomenon motivated by the desire to succeed in sport. The second perspective views the use of AAS as shaped by norms and values embedded in social relationships of formally organized sport. The third perspective suggests that factors outside sport, which have been shown to correlate with the use of other substances, predict the use of AAS. METHOD We use logistic regression and predicted probabilities to analyze data from a national representative survey of 11,031 Icelandic high school students. RESULTS Our results indicated that the use of AAS is not significantly related to participation in formally organized sports. However, it positively relates to fitness and physical training in informal contexts. We found a relatively strong relationship between the use of AAS and the use of illicit substances and a moderate relationship between AAS use and alcohol and tobacco consumption. We also found a significant negative relationship between AAS use and school integration and school achievement, and a significant positive relationship between AAS use and school anomie. The relation between AAS use and family-related variables was weaker. Finally, we found that the relationship between sport participation, physical exercise, and AAS use varies across levels of anomie and integration. CONCLUSION Our findings suggest that the use of AAS and especially illegal substances should be considered more as a social and a health problem rather than a sport specific issue. We found that high school students participating in fitness and informal training outside of formally organized sport clubs are the main risk group and should be the target of prevention efforts. However, this should not be done at the expense of general risk factors that affect AAS and other substances used by the general population. Finally, we suggest that prevention efforts should target both groups and individuals.
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Deshmukh N, Petróczi A, Barker J, Székely AD, Hussain I, Naughton DP. Potentially harmful advantage to athletes: a putative connection between UGT2B17 gene deletion polymorphism and renal disorders with prolonged use of anabolic androgenic steroids. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2010; 5:7. [PMID: 20429943 PMCID: PMC2877023 DOI: 10.1186/1747-597x-5-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 04/29/2010] [Indexed: 01/03/2023]
Abstract
Background and objective With prolonged use of anabolic androgenic steroids (AAS), occasional incidents of renal disorders have been observed. Independently, it has also been established that there are considerable inter-individual and inter-ethnic differences, in particular with reference to the uridine diphosphate-glucuronosyltransferase 2B17 (UGT2B17) gene, in metabolising these compounds. This report postulates the association of deletion polymorphism in the UGT2B17 gene with the occurrence of renal disorders on chronic exposure to AAS. Presentation of the hypothesis The major deactivation and elimination pathway of AASs is through glucuronide conjugation, chiefly catalyzed by the UGT2B17 enzyme, followed by excretion in urine. Excretion of steroids is affected in individuals with a deletion mutation in the UGT2B17 gene. We hypothesize that UGT2B17 deficient individuals are more vulnerable to developing renal disorders with prolonged use of AAS owing to increases in body mass index and possible direct toxic effects of steroids on the kidneys. Elevated serum levels of biologically active steroids due to inadequate elimination can lead to prolonged muscle build up. An increase in body mass index may cause renal injuries due to sustained elevated glomerular pressure and flow rate. Testing the hypothesis In the absence of controlled clinical trials in humans, observational studies can be carried out. Real time PCR with allelic discrimination should be employed to examine the prevalence of different UGT2B17 genotypes in patients with impaired renal function and AAS abuse. In individuals with the UGT2B17 deletion polymorphism, blood tests, biofluid analyses, urinalysis, and hair analyses following the administration of an anabolic steroid can be used to determine the fate of the substance once in the body. Implications of the hypothesis If the hypothesis is upheld, anabolic steroid users with a deletion mutation in the UGT2B17 gene may be exposed to an increased risk of developing renal disorders. In the current detecting - sanctioning anti-doping system, athletes motivated by the potential to evade detection owing to their unique genetic make-up could subject themselves to a serious health consequence. More research on AAS metabolism in the presence of UGT2B17 gene deletion is required. Benefit - harm evaluations in therapeutic use of anabolic steroids should also consider this potential link between UGT2B17 gene deletion polymorphism and renal disorders.
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Affiliation(s)
- Nawed Deshmukh
- School of Pharmacy and Chemistry, Kingston University, London, UK
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Pirola I, Cappelli C, Delbarba A, Scalvini T, Agosti B, Assanelli D, Bonetti A, Castellano M. Anabolic steroids purchased on the Internet as a cause of prolonged hypogonadotropic hypogonadism. Fertil Steril 2010; 94:2331.e1-3. [PMID: 20416868 DOI: 10.1016/j.fertnstert.2010.03.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 03/13/2010] [Accepted: 03/17/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To report a case of hypogonadotropic hypogonadism due to the chronic abuse of anabolic steroids purchased over the Internet. DESIGN Case report. SETTING Endocrinology unit of the University of Brescia. PATIENT(S) A 34-year-old man. INTERVENTION(S) A single dose (100 μg) of triptorelin (triptorelin test). MAIN OUTCOME MEASURE(S) Clinical symptoms, androgen normalization, levels of serum testosterone, follicle-stimulating hormone, and luteinizing hormone. RESULT(S) Within 1 month, the patient's serum testosterone was in the normal range, and he reported a return to normal energy and libido. CONCLUSION(S) The World Anti-Doping Code has proved to be a very powerful and effective tool in the harmonization of antidoping efforts worldwide, but it is insufficient to combat this illegal phenomenon. To tackle the serious side effects caused by doping we believe that it is necessary to increase monitoring and adopt severe sanctions, particularly with regard to Internet sites.
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Affiliation(s)
- Ilenia Pirola
- Internal Medicine and Endocrinology Unit, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy
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